Hartford ERISA Disability Appeal Victory for a Jet Operator Suffering with Chronic Back Pain
Author: Attorney Stephen Jessup
Following an attempt to return to work, Hartford terminated our client’s claim for long term disability benefits. Like so many people who file for disability benefits, he never imagined a day would come that he would not be able to work. Prior to filing for disability benefits, our client worked as a Jet Operator at a major east coast airport. His job entailed that he perform maintenance and repair work around the terminal, oversee fuel operating and dispensing system and be able to “perform heavy physical labor in a safe manner” while having to work outdoors in the extremes of summer heat or winter snow. However, chronic back pain with resultant radiculopathy made it increasingly difficult to continue to perform the duties of his job. In turn, he filed for disability under his employer’s ERISA group disability policy with Hartford.
The Desire To Work
Hartford initially approved his claim for disability payments. While he was on disability he attended numerous medical appointments and physical therapy sessions in an attempt to restore his physical health. The records from these visits clearly indicated his desire to return to work. However, in order to be able to return to work he would need clearance from his employer’s medical doctor. Compounding the matter further was the fact that before he could even meet with his company’s doctor he had to be cleared for work by his treating physician. Despite ongoing physical restrictions he was able to convince his treatment provider to clear him for work so he could at least be examined by the company doctor. This desire to return to work in spite of serious physical limitations would prove costly.
The Denial By Hartford
Our client was ultimately examined by his company’s doctor, who indicated that under no circumstances would he be able to return to his former occupation as a Jet Operator due to his extensive physical restrictions and limitations. Needless to say, our client’s hopes were crushed and he resigned himself to the fact he would be on disability. However, Hartford had other plans. Upon receipt of medical records from his treatment provider, specifically the work clearance, Hartford terminated his claim for benefits, making the simple assertion that his doctor had cleared him to return work.
The Appeal Of Hartford’s Disability Denial
Our client contacted Attorneys Dell and Schaefer following the denial and spoke with Attorney Stephen Jessup. Following a review of the denial letter, it became apparent to Attorney Jessup that Hartford was employing the most liberal of cherry pickings of our client’s medical records to deny the claim. During the course of preparing the appeal, Attorney Jessup acquired copies of all of our client’s medical records as well as a copy of Hartford’s claim file in an attempt to confirm his suspicions as to the denial. Review of the information clearly indicated that Hartford willfully failed to review the report of our client’s company doctor, and ignored the medical records preceding and following the “return to work clearance,” which included repeated indications from his doctors that he was unable to work. Like an ostrich with its head in the sand, Hartford only saw the clearance.
Attorney Jessup consulted with our client’s treatment providers and sought additional clarification as to the reason behind the return to work clearance. In doing so he confirmed that the clearance was meant to serve as nothing more than a way for our client to be examined by his company’s doctor, and in no way was a carte blanche return to work clearance. To further strengthen the claim our client was sent for additional testing that would document his physical restrictions and limitations. Armed with the information compiled during the course of the appeal, Attorney Jessup submitted an extensive appeal to Hartford. Unable to blindly ignore the evidence before them, Hartford overturned its termination of our client’s benefits, put him back on claim and forwarded all back benefits.
The Importance Of What One Medical Record May Say
Although the situation resulting in the denial of benefits may be a little different in this case, it still serves as a reminder of the importance of what one’s medical records say. When reviewing claims for disability benefits it is quite common that insurance companies will focus in on minute portions of medical records as an impetus to deny benefits. Many times indications of a patient “feeling better, sleeping better” or having a “normal physical exam” are enough to prompt a review of a claim for benefits. As such, it is always important to make sure your doctor is properly documenting your records, especially as they relate to restrictions and limitations preventing you from working.
If your claim has been denied or you are concerned that it might be, please feel free to contact Attorneys Dell and Schaefer for a free consultation.